Suicide: How do People Get to that Place to End it All.  And Suicide Prevention

One of the most difficult mental and emotional problems that most people have difficulty understanding, is the state of mind that drives or causes a person to commit suicide.  One of the most difficult and nothing more scary for a family to experience is a loved one having suicidal thoughts and following through with it Probably there is nothing more that can put a Mental Health Professional on high alert than having a client diagnosed with “Suicidal Ideation”. When a family member commits suicide, it can devastate and traumatize members of that family for years. Suicidal ideation, also known as suicidal thoughts, is thinking about, considering, or planning suicide. The range of suicidal ideation varies from fleeting thoughts, to extensive thoughts, to detailed planning. Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor.

According to the Center for Disease Control (CDC) suicide is a leading cause of death in the United States. According to 2017 report published by the CDC Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people. Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people. Suicide was the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54.There were more than twice as many suicides (47,173) in the United States as there were homicides (19,510). There was a 50 % increase in suicides among girls and women between 2000 and 2016, from 4 to 6 per 100,000. Among boys and men between 2000 and 2016 there was a 21% increase from 17.7 to 21.4 per 100,000. And Suicide was the 10th-leading cause of death in the United States in 2016. It was the second-leading cause of death among people ages 10 to 34 and the fourth-leading cause among people ages 35 to 54.

If you have never thought about taking your own life, you may find it difficult to understand why someone would consider dying this way. Experts do not even fully understand why some people would commit suicide, and others would not commit suicide, though a range of mental health issues and life circumstances can play a role. Dr. Roy Baumeister, a noted social psychologist and international authority on self and identity has offered a perspective that may identify the core element underlying suicide.  Baumeister suggested “people who attempt suicide are not trying to kill themselves per se.  That is, their primary goal is not to end their life.  Rather, they are trying to escape exceptionally painful thoughts and feelings about themselves and their lives.  A person amid despair who is contemplating suicide would presumably settle happily for a pill that eliminated negative, painful self-thoughts and feelings over the final act of killing him or herself. Other animals do not kill themselves because they do not have the desperate thoughts and feelings often plague human beings.

A great deal of all the distress that we all experience in life is fed by the ways we talk to ourselves in our own minds. I am not saying that people’s problems are not real. They certainly are: life is filled with unhappy, distressing, and traumatic events that happen to us, as well as many failures to get good things that we desire. That is life. But our problems are magnified many times over because most of us have trouble not thinking about all the bad things that happen.  So, even when we are not directly facing a problem now, we are nonetheless tormented by thoughts about it in our mind.  Our self-thoughts can keep our distress alive almost every waking moment.  not only replay negative events that have happened to us, but we also worry about what is coming down the road.  Even when daily life is okay now, it is sometimes ruined by memories of the past and fears of the future.  And we also ponder the existential implications of the things that happen.  What do they say about me as a person?  Am I incompetent, a failure? Am I a good person or am I evil? Do other people dislike and reject me?  Does my life have any purpose or meaning?  Are my problems solvable, or is my future hopeless?  Can I handle the ongoing unhappiness and pain?  Most of us fall into these patterns of thought at times.  We can’t stop the flood of distressing self-talk and sometimes look for ways to escape our own thoughts.

Some of those ways of escaping our distressing thoughts are mostly beneficial–such as meditating, exercising, listening to music, or getting lost in a good book or movie.  Others are less good for us–excessive alcohol and drug use, overeating, risky behavior, and other escapist activities can sometimes quiet down our existential angst for a while. But, these incessant negative thoughts can send people into chronic depression. Then it fuels even more negative thoughts, making people more miserable and the future look increasingly bleak, and increasing emotional pain and despair. And at some point, when they have reached the limit of torment they can endure, some people, particularly those with a biological predisposition for major depression. may consider suicide to stop the pain.  From the outside, we think their lives are going fine. Inside, their negative ruminations have created an intolerable hell.

Baumeister believes attempting suicide can provide a means of escaping painful thoughts, self-recrimination, and painful feelings in two ways. Most obviously, a person who kills him or herself has effectively solved the problem of intolerable misery. The pain ends, at least for himself or herself although it is just starting for those left behind to try to understand and pick up the pieces of life without that person. However, even when a suicide attempt is unsuccessful, as most are, the simple act of trying to kill oneself may help the person escape negative self-thoughts for a while. Simply thinking about how to kill oneself can produce a state of concrete thinking that minimizes the sort of abstract self-thoughts that create despair. According to Baumeister “when people are contemplating suicide, they think in rigid, narrow, and concrete ways as they focus intently on mundane details of the act. Because concentrating on plans for the suicide mutes’ higher-level thoughts about the past, future, and existential concerns, people sometimes achieve a feeling of emptiness or numbness. People who have attempted suicide often report experiencing a sense of detachment or release as they made their plans, which was an improvement over the despair that prompted them to consider suicide in the first place.”

As Dr. Baumeister observed, “An unsuccessful attempt at suicide may be a successful attempt at escape Although we normally view people who commit suicide as wanting to end their life,”  Baumeister’s “escaping the self” theory suggests that the proximal goal is to stop the painful thoughts and feelings.  That does not mean that the person does not have problems that need to be addressed.  But it does highlight the fact that managing thoughts and feelings through psychotherapy, social support, medication, or a suicide hotline might be the first needed step in getting a person with suicidal thoughts some help . “

Risk Factors

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause. Many different factors contribute to someone making a suicide attempt. But people most at risk tend to share specific characteristics. The main risk factors for suicide are:

  • Depression, other mental disorders, or substance abuse disorder
  • Certain medical conditions
  • Chronic pain
  • A prior suicide attempts
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Having recently been released from prison or jail
  • Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities

Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored. Often, family and friends are the first to recognize the warning signs of suicide and can be the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions. Suicide is complex. Treatments and therapies for people with suicidal thoughts or actions will vary with age, gender, physical and mental well-being, and with individual experiences.

Interventions & Psychotherapies

Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt. Cognitive Behavioral Therapy (CBT) can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their thought patterns and consider alternative actions when thoughts of suicide arise. Dialectical Behavior Therapy (DBT) has been shown to reduce suicidal behavior in adolescents. DBT has also been shown to reduce the rate of suicide in adults with borderline personality disorder, a mental illness characterized by an ongoing pattern of varying moods, self-image, and behavior that often results in impulsive actions and problems in relationships. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.

Medications

Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Because many individuals at risk for suicide often have a mental illness and substance use problems, individuals might benefit from medication along with psychosocial intervention.

If you are prescribed a medication, be sure you:

  • Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you are taking.
  • Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
  • Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.
  • Report serious side effects to the FDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.

Other medications have been used to treat suicidal thoughts and behaviors, but more research is needed to show the benefit of these options.

Collaborative Care

Collaborative Care has been shown to be an effective way to treat depression and reduce suicidal thoughts. A team-based Collaborative Care program adds two new types of services to usual primary care: behavioral health care management and consultations with a mental health specialist. The behavioral health care manager becomes part of the patient’s treatment team and helps the primary care provider evaluate the patient’s mental health. If the patient receives a diagnosis of a mental health disorder and wants treatment, the care manager, primary care provider, and patient work together to develop a treatment plan. This plan may include medication, psychotherapy, or other appropriate options. Later, the care manager reaches out to see if the patient likes the plan, is following the plan, and if the plan is working or if changes are needed to improve management of the patient’s disorders. The care manager and the primary care provider also regularly review the patient’s status and care plan with a mental health specialist, like a psychiatrist or psychiatric nurse, to be sure the patient is getting the best treatment options and improving.

Suicide Prevention

If You Know Someone in Crisis

Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the Lifeline’s website or the Crisis Text Line’s website.

The Veterans Crisis Line connects Service members and Veterans in crisis, as well as their family members and friends, with qualified, caring Department of Veteran’s Affairs (VA) responders through a confidential toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder. You can also start a confidential online chat session at veteranscrisisline.net/get-help/chat.

If You Know Someone in a Crisis

Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the Lifeline’s website or the Crisis Text Line’s website.

The Veterans Crisis Line connects Service members and Veterans in crisis, as well as their family members and friends, with qualified, caring Department of Veteran’s Affairs (VA) responders through a confidential toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder. You can also start a confidential online chat session at veteranscrisisline.net/get-help/chat.

 

~Jim Katsoudas